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Some researchers alternate based on training schedule

David, you mentioned there's research being done to figure out it might reduce heart attacks meaningfully, strokes, and liver and kidney disease

The open label extension (OLE) phase of the Eculizumab study showed a reduction of 75% in the episodes of myasthenic worsening compared to the baseline and rapid improvements in all the myasthenia specific scores

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Additionally, whilst the glucose-dependent mechanisms of both drugs mean hypoglycaemia risk remains low when used without insulin or sulphonylureas, combining them with other glucose-lowering agents could increase this risk

This means its side-effect profile can be different from that of Januvia alone - particularly as metformin can cause stomach upset or diarrhea especially when treatment first begins